Billing code 21355: Cheekbone fractureMedicare rate & RVUs in Delaware
Percutaneous reduction treats a malar fracture through a small access point, using manipulation to restore cheekbone position without open fracture exposure.
Medicare pays $440.84 for 21355 in the office in Delaware (Delaware). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 21355 covers
A surgeon reaches the malar, or cheekbone, fracture through a percutaneous access point and manipulates the bone to restore its position without open exposure. This approach may be performed by an oral and maxillofacial, plastic, or facial trauma surgeon in an operative setting. It is distinct from treatment of a fracture limited to the zygomatic arch and from open repair requiring exposure or fixation.
Report the service when the malar fracture is treated by this percutaneous method. The operative record should identify the fracture, side, access approach, and reduction performed. Related postoperative visits during the 10-day global period are included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. For bilateral treatment, modifier 50 is paid at 150%. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
21355 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | $440.84 | $291.35 |
How the 21355 rate is calculated
Each of 21355’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 21355
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.34Practice expense 8.38Malpractice 0.62
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21355
21355 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21355
Cheekbone fracture
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 21355
Cheekbone fracture
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
21355 without 50 · national office
$445.57
Cheekbone fracture
21355-50 · Bilateral: 150%
$668.36
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
21355 compared with similar codes
Compare codes
21355 vs 21356 vs 21360 vs 21365: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21356Facial fracture repair
- Code 21356 is open treatment of a depressed zygomatic arch fracture; this code is for percutaneous treatment of a malar fracture.
- 21360Malar fracture repair
- Code 21360 describes open treatment of a depressed malar fracture, including internal fixation. Choose this code when the malar fracture is treated percutaneously instead.
- 21365Malar fracture repair
- Code 21365 is for open treatment of a complicated malar fracture. This code describes percutaneous treatment rather than open repair.
21355 billing questions
How does this differ from treatment of a zygomatic arch fracture?
This code is for percutaneous reduction of a malar fracture. A fracture limited to the zygomatic arch may instead fit a code specific to arch treatment, depending on the approach.
Can the manipulation be billed separately?
No. Manipulation used to reduce the malar fracture is part of this percutaneous treatment.
When should an open malar fracture code be considered?
Use an open-treatment code when the surgeon treats the fracture through open exposure. The applicable code depends on the fracture’s characteristics and the repair performed.
How is bilateral treatment reported?
For bilateral treatment, report modifier 50; CMS pays this code at 150%.
What postoperative care is included?
Related postoperative visits for 10 days are included in the global period.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons and team surgery are not permitted for this code.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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